Disorders In Rheumatoid Arthritis Patients Research Articles

Obstructive sleep apnea in patients with rheumatoid arthritis: Correlation with disease activity and pulmonary function tests

Aim of the workTo assess obstructive sleep apnea (OSA) as one of the common primary sleep disorders in patients with rheumatoid arthritis (RA) and study its correlation to disease activity and pulmonary function tests. Patients and methodsThis study included 30 female patients with RA who fulfilled the American College of Rheumatology/European league against rheumatism classification criteria. All the patients were subjected to full medical history, thorough clinical examination with evaluation of the disease activity using disease activity score-28 (DAS28), laboratory assessment of highly sensitive C-reactive protein (hsCRP), pulmonary function tests (PFTs) (FVC, FEV1 and FEV1/FVC) and one night polysomnography at the sleep laboratory. ResultsPolysomnographic data revealed OSA in 14 RA patients (46.7%). Patients with OSA showed longer disease duration (7.0±1.94years), higher BMI (30.8±2.48), hsCRP level (6.7±0.6mg/L) and DAS28 (4.9±1.85) than patients with no OSA (4.0±1.72years, 20.3±1.55, 4.9±0.3mg/L and 3.7±1.28 respectively). There was non-significant difference between both groups regarding the PFTs (p>0.05). The study showed a significant correlation between AHI (apnea-hypopnea index) and BMI, hsCRP and DAS28 (r=0.45, 0.43 and 0.51, respectively) (p<0.05). No significant correlation was detected between AHI and PFTs. ConclusionObstructive sleep apnea is commonly associated with RA patients; these findings possibly suggest common underlying pathological mechanisms which may be linked to chronic inflammation. Co-existence of OSA in RA patients may influence the disease activity and the level of circulating inflammatory markers. Considering diagnosis and treatment of this sleep disorder in RA patients may help in improved clinical care, better prognosis and avoid rheumatoid-associated morbidities.

Modified Sauvé-Kapandji procedure for rheumatoid wrists: A long-term study with a minimum follow-up of 5 years

Objectives. We performed a modified Sauvé-Kapandji procedure for treating disorders of distal radioulnar joint in patients with rheumatoid arthritis (RA). This procedure involves resecting the distal part of the ulna, rotating the resected portion by 90° and fixating it with the distal part of the radius for shelf plasty. The purpose of this study was to examine the clinical and radiographic outcomes of this procedure with more than 5 years’ follow-up.Methods. We studied 32 wrists of 27 RA patients with the mean follow-up of 93.1 months after operation. Pain, grip strength and range of motion of the wrist were examined clinically, while two indices for evaluation of ulnar and palmar translation of the carpus, carpal translation index and palmar carpal subluxation ratio were calculated on radiographs.Results. The wrist pain reduced in all cases. Range of motion increased significantly regarding pronation and supination but decreased significantly regarding flexion. Change in grip power was not significant. No significant differences were recognized between radiographic indices, suggesting carpal alignment was maintained well throughout the follow-up period.Conclusions. We think this procedure could be applied for distal radioulnar joint disorders in RA patients with promising clinical as well as radiographic outcomes over a long period.

AB1432-HPR Level of education, occupation and sleep disorders in patients with rheumatoid arthritis and relationship with disease activity

BackgroundThe rheumatoid arthritis (RA), as known, causes inability in various performance areas mostly in the musculoskeletal. Reduced physical activity, substantial disability and also sleep disorders have previously been described in...

Laryngeal involvement in rheumatoid arthritis

AbstractThe prevalence of laryngeal involvement in Rheumatoid Arthritis (RA) ranges from 13 to 75%. The specific RA manifestations include the cricoarytenoid arthritis and the presence of rheumatoid nodules in the vocal folds. ObjectiveThe objective of this study is to evaluate the prevalence of dysphonia and laryngeal alterations on videolaryngoscopy in RA patients and their association with disease activity. MethodThis is a clinical cross-sectional study that evaluated patients with rheumatoid arthritis as to their disease activity score in 28 joints (DAS-28), laryngeal symptoms, application of a Portuguese version of the Voice Handicap Index and videolaryngoscopy findings, comparing them with a control group. ResultsWe evaluated 47 (54%) patients with rheumatoid arthritis and 40 (46%) controls. The prevalence of dysphonia and videolaryngoscopy changes was respectively 12.8% and 72.4% in patients with RA. The mean of DAS-28 was 3.3 ± 1.2; 26 (74.3%) of 35 patients presenting active disease had laryngeal changes (p = 0.713). Posterior laryngitis was the most common diagnosis (44.7%). ConclusionThe prevalence of laryngeal disorders in RA patients was 72.4% and the prevalence of dysphonia was 12.8%. There was no significant relationship between laryngeal disorders and disease activity.

943 – Mental disorders in rheumatoid arthritis patients: stress factors and pain relations

To analyze the prevalence of stress factors, mental disorders (MD) and their influence on pain in rheumatoid arthritis (RA) patients (pts). 125 RA-pts with a mean age of 47.4±1.01 yrs and disease duration of 138.4±10.1 month were enrolled. The RA disease activity was assessed by DAS-28. BPI was used for pain severity assessment. MD were diagnosed in accordance with ICD-10 criteria. MD were diagnosed in 117 (93.6%) RA pts: depressive episode (n=46,39%) (RDD incl. - 27%); dysthymia (n=41,35%), adjustmend disorders(n=21,18%); GAD (n=9,8%). Mild cognitive disorder was diagnosed in 83 (66.4%) of RA-pts. The significant stress factors preceding RA manifestation were found in 97 (77.6%) cases; in 76 (61%) - stress factors preceded RA exacerbation. Significant chronic stress events during childhood had 84 (67.2%) patients. Patients with MD more often (p< 0.05) had the fourth X-ray stage of RA and maximal stage of functional disability. Mean age of the first prednisone intake was significantly higher (p< 0.05) in patients with MD. RA-pts with severe pain (=7 BPI-points) were 3 times more likely to have depressive disorder than RA-pts with mild pain (1-4 BPI-point) (48.6% vs 15.6%, ?R=3.1, 95% CI=0.97-9.93, ?=0.004). The results have shown high prevalence of stress related MD in RA-pts and confirm the stress-diathesis approach to pathogenesis of MD in rheumatic disease. The RA patients group with MD had high level of pain severity, X-ray stage and functional disability in comparison with patients without MD.

Concurrent psychiatric disorders are associated with significantly poorer quality of life in patients with rheumatoid arthritis

Objectives: To study the effect of concurrent psychiatric disorders on health-related quality of life (HRQOL) in patients with rheumatoid arthritis (RA).Methods: Consecutive Chinese patients who fulfilled the American College of Rheumatology (ACR) criteria for RA were recruited and interviewed by a psychiatrist for psychiatric disorders using the Chinese Bilingual Structured Clinical Interview for DSM-IV Axis I Disorders, Patient version (CB-SCID-I/P). HRQOL was assessed by the validated Chinese version of the 36-item Short Form Health Survey (SF-36). Sociodemographic and clinical data were also collected. Fatigue was assessed by the Functional Assessment of Chronic Illness Therapy – Fatigue scale (FACIT-F).Results: Two hundred patients with RA were studied (79% women, mean age 51.4 ± 10.5 years; median RA duration 4.0 years). Forty-seven (23.5%) patients were diagnosed with a psychiatric disorder: depressive disorders in 29 patients and anxiety disorders in 26 patients. Patients with either condition had significantly higher fatigue scores (26 ± 8.8 vs. 16 ± 6.9, p < 0.001) and were more likely to be unemployed (p = 0.02) and dependent on government subsidy for living (p < 0.001) than those without. The scores of the eight domains and the physical and mental components of the SF-36 were significantly lower in RA patients with psychiatric disorders (p < 0.001 in all). In a linear regression model, the presence of either depressive or anxiety disorders (β = −0.23, p < 0.001), older age (β = −0.16, p = 0.006), self-perceived pain (β = −0.25, p < 0.001) and fatigue (β = −0.42, p < 0.001) were independently and inversely associated with the total SF-36 score after adjustment for disease activity and other sociodemographic variables.Conclusions: Concomitant depressive or anxiety disorders in RA patients are associated with significantly poorer HRQOL. Early identification and treatment of psychiatric disorders in RA patients are warranted.

Contrasting diagnosis performance of forced oscillation and spirometry in patients with rheumatoid arthritis and respiratory symptoms

OBJECTIVES:Pulmonary involvement in rheumatoid arthritis is directly responsible for 10% to 20% of all mortality. The best way to improve the prognosis is early detection and treatment. The forced oscillation technique is easy to perform and offers a detailed exam, which may be helpful in the early detection of respiratory changes. This study was undertaken to (1) evaluate the clinical potential of the forced oscillation technique in the detection of early respiratory alterations in rheumatoid arthritis patients with respiratory complaints and (2) to compare the sensitivity of forced oscillation technique and spirometric parameters.METHODS:A total of 40 individuals were analyzed: 20 healthy and 20 with rheumatoid arthritis (90% with respiratory complaints). The clinical usefulness of the parameters was evaluated by investigating the sensibility, the specificity and the area under the receiver operating characteristic curve. ClinicalTrials.gov: NCT01641705.RESULTS:The early adverse respiratory effects of rheumatoid arthritis were adequately detected by the forced oscillation technique parameters, and a high accuracy for clinical use was obtained (AUC>0.9, Se = 80%, Sp = 95%). The use of spirometric parameters did not obtain an appropriate accuracy for clinical use. The diagnostic performance of the forced oscillation technique parameters was significantly higher than that of spirometry.CONCLUSIONS:The results of the present study provide substantial evidence that the forced oscillation technique can contribute to the easy identification of initial respiratory abnormalities in rheumatoid arthritis patients that are not detectable by spirometric exams. Therefore, we believe that the forced oscillation technique can be used as a complementary exam that may help to improve the treatment of breathing disorders in rheumatoid arthritis patients.

Correlation between serum osteoprotegerin and atherosclerotic vascular disorders in rheumatoid arthritis patients

Aim of the workThe aim of the present study was to investigate the association of serum osteoprotegerin (OPG) level with the presence of angiographically documented asymptomatic coronary artery disease (CAD) in patients with rheumatoid arthritis (RA) and to evaluate its relationship with plasma thrombomodulin (TM), as a marker of endothelial dysfunction and with carotid artery intima media thickness (IMT), as a marker of atherosclerosis. Patients and methodsThe study included 20 rheumatoid patients without CAD (negative results on exercise ECG stress test) and other 20 rheumatoid patients with CAD (positive results on exercise ECG stress test and confirmed by coronary angiography). In addition, 20 age and sex matched normal control subjects were studied. Serum OPG and plasma TM levels were measured and carotid artery IMT was determined. ResultsThe study revealed that serum OPG levels were significantly higher in rheumatoid patients with and without CAD than in controls (P<0.001, P<0.01; respectively) and were positively correlated with age, duration of disease, Disease active score 28(DAS28), Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and carotid IMT in rheumatoid patients with and without CAD. Serum OPG level was correlated significantly with plasma TM only in rheumatoid patients with CAD (P<0.001). ConclusionOsteoprotegerin is a clinically important molecule independently associated with the presence of coronary artery disease and may be a good indicator of atherosclerotic vascular damage and macroangiopathy in asymptomatic rheumatoid patients. Hence, measurement of serum OPG merits further investigation as a simple test for improving early diagnosis of asymptomatic CAD in rheumatoid patients.

Mycobacterium-associated Lobular Panniculitis, Mimicking a Rheumatoid Nodule in a Patient With Rheumatoid Arthritis

Mycobacterium-associated lobular panniculitis can mimic a rheumatoid nodule and has been seldom reported in rheumatoid arthritis (RA). We describe a 69-year-old woman with RA who presented initially with fever and an indurated skin lesion on the right thigh. Lobular panniculitis was diagnosed after biopsy and was then treated with prednisolone. After this therapy, pulmonary infiltration developed and was later shown by transbronchial biopsy to be caused by Mycobacterium tuberculosis. The panniculitis skin lesion became smaller after prednisolone therapy and was further improved after antituberculosis drugs were added. Reexamination of the previously biopsied skin tissue disclosed acid-fast bacilli. Reactivation or new infection of M. tuberculosis is a current important issue in RA patients, especially after treatment with disease-modifying anti rheumatic drugs or antitumor necrosis factor agents. Mycobacterium-associated lobular panniculitis should be included in the differential diagnosis of indurated skin disorder in RA patients, and acid-fast staining or polymerase chain reaction examination of tuberculosis should be performed routinely on biopsied skin tissue.

Prevalence of thyroid diseases and antithyroid antibodies in women with rheumatoid arthritis

Thyroid abnormal function and and/or autoimmune thyroid disease (ATD) are observed in 6% to 33.8% patients with rheumatoid arthritis (RA). The aim of the study was to determine whether ATD is more prevalent in patients with RA compared to the control group involving age and sex-matched subjects without RA and whether these patients should be screened for thyroid disease. In 100 patients with RA and 55 patients without RA (control group) hormonal thyroid function and antithyroid antibodies were assessed. ATD was more prevalent (16%) in patients with RA than in the control group (9%). The difference was no statistically significant. The RA patients with concomitant ATD had lower RA activity than non-ATD RA patients. Antithyreoglobulin (anti-TG) and antithyroid peroxidase (anti-TPO) antibodies were present in similar percentage of patients with RA (12% and 15%, respectively) and in the control group (9% and 18%, respectively). The most common thyroid dysfunction observed in both groups was subclinical hypothyroidism. An association between thyroid dysfunction and clinical symptoms suggestive of thyroid disease in RA patients was not demonstrated. In patients with RA low free triiodothyronine concentrations were significantly more common. A higher prevalence of ATD in female RA patients compared with controls indicates the need for screening not only of thyroid function, but also of the presence of anti-TPO antibodies as the ATD marker in RA patients. Their presence does not correlate with the occurrence of thyroid disorders in RA patients. Monitoring of thyroid function is of particular importance since as already shown the course of thyroid disease in RA patients is often asymptomatic.

Rheumatoid arthritis is associated with a high prevalence of hypothyroidism that amplifies its cardiovascular risk

Objective:Rheumatoid arthritis (RA) patients have an increased risk of developing cardiovascular diseases (CVD). Other autoimmune diseases such as hypothyroidism are also associated with an enhanced risk for CVD. Our objective...

Análise dos índices de Helkimo e craniomandibular para diagnóstico de desordens temporomandibulares em pacientes com artrite reumatóide

OBJETIVO: O estudo teve como finalidade avaliar a utilização de dois índices (Helkimo e craniomandibular) para o diagnóstico da desordem temporomandibular (DTM) em pacientes com Artrite Reumatóide (AR). MATERIAIS E MÉTODOS: A amostra foi de 80 pacientes divididos em dois grupos: pacientes com AR e pacientes sem AR. Em ambos os grupos os dois índices foram utilizados. No diagnóstico da DTM foram avaliados os seguintes sinais e sintomas: dor na ATM; limitação de abertura de boca e ruídos articulares. RESULTADOS: Os resultados mostram que dos pacientes com AR 87,1% eram do gênero feminino e 12,9% do masculino. Entre os pacientes sem AR, 70% eram do gênero feminino e 30% do masculino. A idade dos pacientes com AR variou de 24 a 78 anos. Entre os pacientes sem AR, a idade variou de 22 a 72 anos. Foi verificado que a prevalência de DTM foi mais elevada no grupo de pacientes com AR (98,6% - Helkimo e 87,1% - craniomandibular) do que no grupo sem a doença (80% - Helkimo e 50% - craniomandibular). CONCLUSÃO: Em resumo, temos que ambos os índices são capazes de diagnosticar a desordem temporomandibular em pacientes com AR, entretanto o Índice de Helkimo é menos preciso.

Analysis of helkimo and craniomandibular indexes for temporomandibular disorder diagnosis on rheumatoid arthritis patients

SummaryAim: The aim of this study was to evaluate the use of two indexes (Helkimo and Craniomandibular) for the diagnosis of temporomandibular disorder (TMD) in patients with Rheumatoid Arthritis (RA).Patients and methodsThe sample was composed of 80 patients divided into two groups: patients with RA and patients without RA. In both groups the two indexes were used. For TMD diagnosis, the following signs and symptoms were evaluated: TMJ pain, limited mouth opening and joint sounds.ResultsResults showed that of the RA patients, 87.1% were females and 12.9% were males. Among the patients without RA, 70% were females and 30% were males. The age of these RA patients ranged between 24 and 78 years. Among patients without RA, the age of the patients ranged between 22 and 72 years. It was observed that the prevalence of TMD was higher in the group with RA (98.6% - Helkimo and 87.1% - Craniomandibular) when compared to the group without the disorder (80% - Helkimo and 50% - Craniomandibular).ConclusionIn summary, one could conclude that both indexes are capable to diagnose temporomandibular disorders in RA patients, although the Helkimo index is less accurate.